Scairbh

Na

gCaorach

EMYVALE

At the meeting of the Community Alliance last night (Tuesday, November 15th) frustration was once again expressed by all members that many of the public seem to have capitulated to the decisions of Government and the HSE to reduce the opening hours of the Minor Injuries Unit, and the general downgrading of our hospital. However those who have experienced the need for emergency services and the need for services closer to home and those who have spent time lying on trolleys in another hospital, know the justification for the Alliance’s campaign against these cuts. Unfortunately, but thankfully in another way, not enough people have experienced the added trauma, cost and inconvenience to convince them that we need these decisions reversed and that action needs to be taken to let the decision makers know that their plans are not acceptable to the people of Monaghan. People should not wait until they have the experience - act now to prevent you having to suffer later.

Dr. John Barton in the Irish Times last Wednesday clearly explained how these decisions were being made without any proof that it is the safest and most cost effective way to go.  Indeed he showed from research that the wrong decisions are being made and implemented and that our health system will only get worse. His statements are backed up by the fact that Dr. Barry resigned his position on HIQA as he was not happy that that organisation was making the proper decisions about the closure of small hospitals when international evidence is considered.  The spindoctors of the previous and present Governments and the HSE have bombarded the public with terms like ‘best international practice’; ‘Safer and better services’; ‘multidisciplinary teams’; ‘specialist services’; in the public interest’;  etc etc and the public have been lulled into believing that these spindoctors have the evidence to prove their point but despite our constant requests this proof has not been presented and cannot be as it is not there.

Professor John Robb, an eminent Consultant with worldwide experience, also rejects the decisions being made to remove acute in-patient services and A & Es and basically close hospitals like Monaghan.(an extract from his writings is printed below).  Why is Government not listening to experts like these? The answer is very simple – because there is another agenda and other people to be satisfied and money to be made from the illnesses of people. There is no logical reason for many of these decisions other than to gratify the wants of certain groups and interests. For example why are decisions made which forces more and more sick people to travel into an overcrowded city for services and at the same time spend billions of euro to try to improve the transport system to cope with the huge extra numbers coming in to the city. This is not a prudent use of our taxes.

The blanket plan to centralise services is another flawed decision as only 80% of illness which require hospitalisation need the high tech specialist treatment which is provided in tertiary hospitals yet we are reaching the point where every patient which needs in-patient care will have to go to one of these high tech hospitals. The costs of treating relatively minor illnesses in such hospitals cannot be justified and is a total waste of time, money and expertise.

The Alliance has decided that its campaign will continue and will persist in its efforts to highlight the faulty decision making and defective system being imposed on the people of Monaghan. Requests for inspections to Fire Authorities in Cavan and Louth, requests to the health and safety Authority, and requests to HIQA seem to have fallen on deaf ears as there has been no responsive action from these organisations. It was decided at the meeting that these requests be followed up.

(Extract from John Robb’s submission)

In Scotland the problem of the survival of acute medical, obstetrical and, in particular, acute surgical service in rurally and remotely located communities has been confronted by the ‘Viking Surgeons’. This group first convened in 1973 to express the voice of professional concern about the demise of these smaller community-serving, ‘Acute’ hospitals.  Their main objective has been to make realistic proposals: firstly for the continuation of functioning  acute services locally situated; secondly,  to devise more appropriate training to meet the challenge; and thirdly, to encourage the medical schools to become pro-active in ensuring that students obtain significant exposure to practice in rural and remote locations.  The aim is to equip young graduates appropriately to measure up to the particular clinical challenges of holding down effectively, economically and efficiently, the surgical service in the smaller hospitals serving these rural and remotely located communites.   The ‘Vikings’ of which the author of ‘Long Live the Small ‘Acute’ Hospital’, is a long-term member have succeeded in changing attitudes of ‘the powers that be’ in the Scottish Royal Colleges to the point where they now acknowledge that there is need to have training programmes tailored to the particular challenges of small hospital ‘acute’ practice.

When Consultant surgeon , Rex Lawrie ( Guys Hospital, London), had his article published in the prestigious surgical journal,’ The Annals of the Royal College of Surgeons,’  he stated, in spite of spending his working life as a consultant in a London teaching hospital, Guys hospital,  that 80-90% of all acute surgical problems should be within the compass of the small ‘Acute’ hospital  including the management of trauma.

Politicians and other power brokers must be persuaded to pay as much attention to the personnel and people living in rural and remote communities as they do to professors and other prominent academics who may have a vested interest in centralisation

In this era of ever increasing super-specialisation it is simply not good enough to have superbly trained surgeons in the specialties already mentioned. And, at the same time overlook the very special training programme which should have been devised for the ‘specialty’ of Community Surgery.  There is not enough life-time to become a super-specialist in all of the specialist disciplines yet, as is exemplified in ‘Long Live the Small ‘Acute Hospital’ a surgeon wanting to practice effectively in a rural or remotely located community may be trained to be effective in 80% of cases including emergencies.  

The booklet, ‘Long Live the Small ‘Acute’ Hospital’ has been written to highlight some of the difficulties of small hospital practice and the reasons why communities which have developed and maintained  such  practice should retain it in a contemporary context, so that by doing so, local confidence and morale which are the very essence of community well-being, are sustained. The small church, school, Post Office, transport and small shops all contribute to this sense of ‘well-being’ which ‘Long Live the Small ‘Acute’ Hospital’ describes as central to  individual and collective community health.  Removing any of those still functioning is a blow to community morale and well-being. The classic confirmation of the trend has been oft stated by George Monbiot in the Guardian :it has also been expressed by him in The Ecologist

Finally, let us be done with flaunting the statement,’Centres of Excellence’ as if excellence  cannot exist outside of a centre.  Having had experience of work in hospitals in the U.K., Middle East, South and Central Africa and had opportunity to study undergraduate teaching and postgraduate training in the USA and Canada, it is right to strive for excellence but arrogant to be suggesting that it may only be achieved centrally.

Blind Capitulation